Case study: How integrating post-acute and palliative services reduces total cost of care for health plans
Integrated post-acute and palliative care helps health plans reduce total cost of care by improving engagement among high-risk members, decreasing avoidable inpatient admissions, and coordinating serious illness management across settings. While evaluated within a Medicare Advantage population, the model is scalable across lines of business.
The executive problem
Serious illness and post-acute transitions represent some of the most expensive and fragmented points in the member journey. These challenges extend across Medicare Advantage, Medicaid, and Commercial populations, where high-acuity members disproportionately drive total cost of care.
Many health plans are under pressure to improve outcomes for high-cost members while maintaining financial discipline. Yet disconnected post-acute oversight and delayed palliative engagement make it difficult to manage serious illness spend with clarity.
Carelon evaluated whether integrating Carelon Post-Acute Solutions with Carelon Palliative Care could drive earlier engagement and clearer financial impact.
The results
In this case study, you’ll see how integrating post-acute utilization management with palliative care for health plans produced measurable improvements in both clinical and financial performance.
The integrated model delivered:
- 22% higher engagement among Post-Acute referrals
- 27% reduction in acute inpatient admissions
- 31% incremental savings driven by higher engagement
- 42% attribution of savings due to in-patient and ER reduction
Analysis based on CY2023 referral data comparing engaged and non-engaged cohorts, adjusted for baseline risk. This case study is designed for health plan executives, medical directors, and population health leaders seeking scalable serious illness cost management strategies
The Carelon approach to serious illness care
What is integrated post-acute and palliative care?
Integrated post-acute and palliative care aligns discharge oversight, serious illness management, and member engagement to reduce avoidable utilization and improve total cost of care.
How does integrated serious illness care reduce hospital admissions?
Earlier identification of high-risk members, aligned goals of care, and coordinated symptom management reduce crisis-driven inpatient utilization across serious illness populations.